Conditions
Shoulder pain and injuries
The shoulder trades stability for range: it moves further than any other joint, and it relies on muscle and timing rather than bone to stay in place. That is why most shoulder pain responds to the right exercise — and why the wrong exercise makes it worse. This page covers what we see most, what therapy does for each, and when a doctor needs to look first.
See a doctor first
Shoulder pain with any of the following needs a physician or an emergency department before a therapy visit:
- A visible deformity, or a shoulder that has come out of joint
- Sudden loss of the ability to lift the arm after a fall or a heavy pull, which can be a complete rotator cuff tear
- A hot, swollen, red joint with fever
- Shoulder or arm pain that comes on with exertion together with chest pressure, breathlessness or sweating — call 911
- Pain with a lump, unexplained weight loss, or a history of cancer
What we see most
Shoulder conditions we treat, and what therapy does for each.
Rotator cuff tendinopathy and tears
The four rotator cuff tendons keep the ball centered in the socket. They become irritated with overuse, and with age they fray and tear — partial tears are common over 50, and many cause no pain at all.
What therapy does: For rotator cuff pain without a complete tear, exercise therapy has the strongest evidence, and randomized trials have found it produces results similar to surgery for many degenerative tears. We load the cuff progressively, restore the shoulder blade's control, and adjust how you lift and reach. A full-thickness tear in a younger person after an injury is a different problem and needs a surgeon's opinion promptly.
Shoulder impingement (subacromial pain)
Pain when lifting the arm out to the side or overhead, often a painful arc between roughly 60 and 120 degrees. Very common in people who work or train overhead.
What therapy does: The old idea that a bone spur is pinching the tendon has given way to a better one: the tendon is overloaded and the shoulder's control has drifted. Graded strengthening of the cuff and the muscles around the shoulder blade is the treatment, and it outperforms decompression surgery in trials. Injections can settle a flare but do not fix the cause.
Frozen shoulder (adhesive capsulitis)
The joint capsule tightens and the shoulder loses range in every direction, with deep pain that is often worst at night. Most common between 40 and 60, and more common in people with diabetes or thyroid disease.
What therapy does: Frozen shoulder runs its own course — typically a painful stage, a stiff stage and a recovery stage — over one to three years. Therapy cannot shorten the biology, and anyone who promises to cure it in weeks is overselling. What it does is keep as much range as the stage allows, manage pain, and speed the thawing phase. Working through severe pain in the early stage makes it worse, so pacing is part of the treatment.
Shoulder instability and dislocation
A shoulder that has come out of joint, or feels as though it might. First dislocations in teenagers and young adults recur often; in older adults the concern is usually a rotator cuff tear alongside.
What therapy does: After a dislocation is reduced, therapy restores the muscular control that keeps the ball in the socket, then rebuilds strength for your sport or your job. For young athletes with repeated dislocations, stabilization surgery has a lower recurrence rate than rehabilitation alone, and we will tell you when that conversation is worth having.
Post-surgical rehabilitation
Recovery after rotator cuff repair, labral repair, stabilization or shoulder replacement. Each has a protocol, with periods where the repair must be protected before it can be loaded.
What therapy does: We follow your surgeon's timeline exactly. Early on the job is protecting the repair and keeping the rest of you moving; later it is regaining range, then strength, then the specific overhead demands of your life. Rushing the early phases is the most common way a good repair fails.
Do you need a scan first?
Usually not. Ultrasound and MRI find rotator cuff tears in a large share of people over 50 who have no shoulder pain, so a scan can name a culprit that is not actually the problem. For shoulder pain without red-flag signs, a physical examination and a few weeks of treatment tell us more.
Imaging becomes useful when there was a clear injury with sudden weakness, when the shoulder is unstable, or when a proper trial of therapy has not moved things. We refer when that point is reached, not before.
What treatment looks like
The first visit maps the problem: which movements hurt, how far the shoulder goes actively versus when we move it for you, how strong the rotator cuff is, and how the shoulder blade and upper back are contributing — because they nearly always are.
Treatment is built around progressive loading of the cuff and the muscles that control the shoulder blade, with hands-on treatment for stiffness and pain. Posture advice on its own does little; strength and control are what change symptoms. For overhead athletes and workers we finish with the specific demands of the task, not a generic program.
Most shoulder problems are seen once or twice a week for six to twelve weeks. Frozen shoulder is measured in months, and we say so at the start.
How we treat it
The services that apply.
Physical Therapy
Pain and movement problems treated without drugs or surgery. Offered at every clinic.
Learn moreDry Needling
A thin-needle technique for tight muscle, used inside a wider plan — never on its own.
Learn moreHand Therapy
A separate specialty with its own certification, for the part of you that does the fine work.
Learn more
FAQ
Common questions
- Can a rotator cuff tear heal without surgery?
- A torn tendon does not knit itself back together, but many rotator cuff tears — particularly degenerative tears in people over 50 — become pain-free and fully functional with exercise therapy, and trials comparing therapy with surgery for these tears show similar outcomes. Acute full-thickness tears in younger people after an injury usually do need surgical repair.
- How long does frozen shoulder take to get better?
- Typically one to three years from the first symptoms, through painful, stiff and recovery stages. Physical therapy keeps as much movement as each stage allows and can speed the recovery phase, but no treatment reliably shortens the overall course.
- Should I stop lifting or working overhead if my shoulder hurts?
- Modify, do not stop. Complete rest weakens the rotator cuff and usually delays recovery. Your therapist will adjust the load, range and frequency so you keep working and training while the shoulder settles.
- Is shoulder pain ever a sign of a heart problem?
- Rarely, but yes. Shoulder or arm pain that comes on with exertion together with chest pressure, breathlessness, nausea or sweating can be cardiac. Call 911 rather than booking a therapy visit.
Sources
- Rotator Cuff Tears — OrthoInfo, American Academy of Orthopaedic Surgeons
- Frozen Shoulder — OrthoInfo, American Academy of Orthopaedic Surgeons
- Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial — The Lancet, 2018
- Treatment of non-traumatic rotator cuff tears: a randomised controlled trial with one-year clinical results — The Bone & Joint Journal, 2014
- Shoulder pain — NHS
This page is general information, not a diagnosis. A physical therapist at any SportsCare clinic can evaluate your specific situation.